Lantus vs. levemir

[Nejeda]

My doctor just switched me from Lantus to Levemir, but he didn't explain the difference it would have on my blood sugar, or on me. I tried to research it, but I came up with a whole lot of nothing... can anyone give me some information?

Thanks...

~Nejeda~

[liz32]

I just switched last month from lantus to levemir. As far as amounts went I was told unit for unit and that has held true for me. I don't use anymore levemir than lantus. I did find that while on lantus I was always hungry and craved stuff all the time. When I switched I noticed that my appetite all but disapeared. I even had a hard time trying to eat at the begining. It's been just over a month and my appetite is starting to return. I love using the pen for the levemir which isn't available with lantus. I hope you have a good effect with the levemir. I certainly have...so far. lol
Liz

[opdaddy]

I just switched last month from lantus to levemir. As far as amounts went I was told unit for unit and that has held true for me. I don't use anymore levemir than lantus. I did find that while on lantus I was always hungry and craved stuff all the time. When I switched I noticed that my appetite all but disapeared. I even had a hard time trying to eat at the begining. It's been just over a month and my appetite is starting to return. I love using the pen for the levemir which isn't available with lantus. I hope you have a good effect with the levemir. I certainly have...so far. lol
Liz

the pen is available with lantus i have it and i am using it. who told u it wasnt available?

[psilocybin]

i heard that levemir was more predictable from numerous doctors......

[liz32]

Lantus pen isn't availible here in Canada. I've heard a few conflicting reports that it's coming in Christmas this year and other pharmacists have said that it's never coming as the manufacturer can't be bothered producing them for Canada. I've also been told that Americans in general aren't big pen users but from what I've read here that doesn't seem to hold true. I must admit thought, that even if they did bring out a lantus pen here I wouldn't switch back. It's so nice not being hungry 24/7 (that was my side effect of lantus).
Liz

[bonnie690]

Levemir over lantus anyday, lantus makes you eat like there is no tommorrow, you have more control on levemir i do have to do more levemir but at the end of the day as long as it works!

[opdaddy]

Levemir over lantus anyday, lantus makes you eat like there is no tommorrow, you have more control on levemir i do have to do more levemir but at the end of the day as long as it works!


why does lantus make you eat more?

[Nejeda]

My doctor mentioned that with levemir there was less of a risk of me gaining weight... anything to do with the eating or is it in the insulin itself?

[liz32]

It just seems that the side effect of taking lantus is a constant appetite and craving. It's almost rediculous how much you want to eat. The levemir is easier.
Liz

[bonnie690]

I have no idea why lantus does make you eat more all iknow is i was constantly hungry! and i'm not the only one other diabetic i have spoke to have said it too. I find levemir so much easier i have nearly halved what i eat on it! some people say you have to do levemir twice a day but i don't i find that it works for 24 hours as the makers say!:tee:

[Mick]

I was on Lantus for 6 years, up until yesterday, when my doc handed me a vial of Levemir and told me to try it. I NEVER was hungry all the years I took Lantus--I didn't gain weight, and in fact kept loosing weight during that time... The reason for the switch was that I was not getting 24 hour coverage with the Lantus, more like 20, with coverage between dinner and bedtime coming from extra bolus with my dinner injection to cover. So far, I've had nothing but grief!! Woke up at 5AM VERY low, was over 300 by 10AM, low again after lunch, high again before dinner--I have been bouncing up and down until I feel like I'm in a fist fight--and I'm not winning! BUT--I am going to take a unit less of the Levemir tonight, test every hour, and see if I can get this evened out--I'll keep ya'll posted. The proof of the pudding, as far as 24-hr coverage, will be tonight--I did not bolus extra with dinner to cover, so we'll see what my test is in a few hours... Hope for the best!

Michael
T1 since 1966

[vrocco1]

I just learned this week that the study that indicated Levemir does not cause weight gain compared Levemir to NPH, not to Lantus. Both insulins (Lantus and Levemir) are weight gain neutral from what I hear. You have to be careful about the advertisments.

[Pitzi]

the pen is available with lantus i have it and i am using it. who told u it wasnt available?We have Lantus pens here in SA :) I have a nice blue one. how nice not having to use syringes anymore

[BriOnH]

I was on Lantus for 6 years, up until yesterday, when my doc handed me a vial of Levemir and told me to try it. I NEVER was hungry all the years I took Lantus--I didn't gain weight, and in fact kept loosing weight during that time... The reason for the switch was that I was not getting 24 hour coverage with the Lantus, more like 20, with coverage between dinner and bedtime coming from extra bolus with my dinner injection to cover. So far, I've had nothing but grief!! Woke up at 5AM VERY low, was over 300 by 10AM, low again after lunch, high again before dinner--I have been bouncing up and down until I feel like I'm in a fist fight--and I'm not winning! BUT--I am going to take a unit less of the Levemir tonight, test every hour, and see if I can get this evened out--I'll keep ya'll posted. The proof of the pudding, as far as 24-hr coverage, will be tonight--I did not bolus extra with dinner to cover, so we'll see what my test is in a few hours... Hope for the best!

Michael
T1 since 1966

Michael,
Look forward to your report, and your findings. I really like lantus, and have no desire to switch, but have a weird feeling that since levemir is made by the makers of novolog(I need to double check on that though) that my insurance company will switch from lantus to levemir by getting a better deal by bundling up with levemir / lantus. Lantus has been the best insulin I have ever been on imo, but will not be closed minded if there is a better insulin out there. Hoping for the best for you!

[mark-TN]

Apparently the weight gain issue pertains to both NPH and Lantus (Insulin Glargine) when compared to Levemir. Here is a copy of an article posted on Diabetes In Control today:

ADA: Ten Thousand Patients Using Levemir Insulin Show Improvements in BG Without Weight Gain
on Tuesday, June 13 @ 13:11:26 CDT

Levemir reduced mean A1C levels by 0.54 percent for type 1 and 0.89 percent for type 2 diabetes patients.

Novo Nordisk announced results from the German cohort of 10,276 patients enrolled in the observational PREDICTIVE(TM) trial, which found Levemir(R) (insulin detemir [rDNA origin] injection) improved blood sugar control (A1C) and reduced episodes of major hypoglycemia (low blood sugar) with no weight gain in actual clinical practice. The primary endpoint was safety.

In PREDICTIVE, Levemir demonstrated significant improvement in blood sugar control - A1C levels were reduced significantly in both type 1 and type 2 diabetes patients. In addition, patients with type 2 diabetes lost weight, while type 1 patients maintained their weight while using Levemir. Weight gain is a common side effect of insulin therapy(1) and Levemir is the first insulin to show less weight gain versus other basal insulins in 12 of 12 controlled clinical trials. Among people with diabetes, 90 to 95 percent have type 2 diabetes(2) and 80 percent of people with diabetes are overweight or obese(3).

Additionally, an analysis of a sub-group of this study of type 2 diabetes patients (n=511) focused on patients who switched from NPH or glargine to Levemir. These patients experienced significant improvement in A1C, and reduced episodes of major hypoglycemia. Both patient groups also experienced weight reduction.

PREDICTIVE Study Key Findings (Poster# 511-P)
These results and the findings of a separate sub-group analysis were presented at the 66th Scientific Sessions of the American Diabetes Association in Washington, D.C.

[Pitzi]

This thread is very interesting. especially the hunger issue. ever since I was put on insulin treatment, I have been suffering from an insatiable appetite. To a point where it actually scares me! Might be something to do with the insulin I take?

[vrocco1]

Apparently the weight gain issue pertains to both NPH and Lantus (Insulin Glargine) when compared to Levemir. Here is a copy of an article posted on Diabetes In Control today:

ADA: Ten Thousand Patients Using Levemir Insulin Show Improvements in BG Without Weight Gain
on Tuesday, June 13 @ 13:11:26 CDT

Levemir reduced mean A1C levels by 0.54 percent for type 1 and 0.89 percent for type 2 diabetes patients.

Novo Nordisk announced results from the German cohort of 10,276 patients enrolled in the observational PREDICTIVE(TM) trial, which found Levemir(R) (insulin detemir [rDNA origin] injection) improved blood sugar control (A1C) and reduced episodes of major hypoglycemia (low blood sugar) with no weight gain in actual clinical practice. The primary endpoint was safety.

In PREDICTIVE, Levemir demonstrated significant improvement in blood sugar control - A1C levels were reduced significantly in both type 1 and type 2 diabetes patients. In addition, patients with type 2 diabetes lost weight, while type 1 patients maintained their weight while using Levemir. Weight gain is a common side effect of insulin therapy(1) and Levemir is the first insulin to show less weight gain versus other basal insulins in 12 of 12 controlled clinical trials. Among people with diabetes, 90 to 95 percent have type 2 diabetes(2) and 80 percent of people with diabetes are overweight or obese(3).

Additionally, an analysis of a sub-group of this study of type 2 diabetes patients (n=511) focused on patients who switched from NPH or glargine to Levemir. These patients experienced significant improvement in A1C, and reduced episodes of major hypoglycemia. Both patient groups also experienced weight reduction.

PREDICTIVE Study Key Findings (Poster# 511-P)
These results and the findings of a separate sub-group analysis were presented at the 66th Scientific Sessions of the American Diabetes Association in Washington, D.C.

They never do mention Lantus by name when talking about weight gain. Maybe you can post a link to this document. I'd like to see what footnote 1 says.

[mark-TN]

They never do mention Lantus by name when talking about weight gain. Maybe you can post a link to this document. I'd like to see what footnote 1 says.
Glargine = Lantus (https://www.lantus.com/consumer/index.do)

Additionally, an analysis of a sub-group of this study of type 2 diabetes patients (n=511) focused on patients who switched from NPH or glargine to Levemir. These patients experienced significant improvement in A1C, and reduced episodes of major hypoglycemia. Both patient groups also experienced weight reduction.

The rules of this forum forbid me from posting a link to the site were this article was posted but if you do a google search for Diabetes in Control you will find the site and the article. FYI- the footnotes were not included in the Diabetes in Control article (I copied and pasted it in its entirety, but this is a finding direct from the ADA 66th Scientific Sessions: PREDICTIVE Study Key Findings (Poster# 511-P)
These results and the findings of a separate sub-group analysis were presented at the 66th Scientific Sessions of the American Diabetes Association in Washington, D.C.

[vrocco1]

Thanks Mark, I understand that Lantus is Glargine, but I still don't see the comparison to Lantus (refering to weight gain) in the portion of the document you posted. I'll go look at it myself. Thanks again!

[Pitzi]

I sure **** hope that Lantus makes me gain weight, I sure need it! :p

[mark-TN]

Thanks Mark, I understand that Lantus is Glargine, but I still don't see the comparison to Lantus (refering to weight gain) in the portion of the document you posted. I'll go look at it myself. Thanks again!

It's is the bold blue paragraph with glargine and weight reduction underlined, I promise.:biggrin:
Apparently the weight gain issue pertains to both NPH and Lantus (Insulin Glargine) when compared to Levemir. Here is a copy of an article posted on Diabetes In Control today:

ADA: Ten Thousand Patients Using Levemir Insulin Show Improvements in BG Without Weight Gain
on Tuesday, June 13 @ 13:11:26 CDT

Levemir reduced mean A1C levels by 0.54 percent for type 1 and 0.89 percent for type 2 diabetes patients.

Novo Nordisk announced results from the German cohort of 10,276 patients enrolled in the observational PREDICTIVE(TM) trial, which found Levemir(R) (insulin detemir [rDNA origin] injection) improved blood sugar control (A1C) and reduced episodes of major hypoglycemia (low blood sugar) with no weight gain in actual clinical practice. The primary endpoint was safety.

In PREDICTIVE, Levemir demonstrated significant improvement in blood sugar control - A1C levels were reduced significantly in both type 1 and type 2 diabetes patients. In addition, patients with type 2 diabetes lost weight, while type 1 patients maintained their weight while using Levemir. Weight gain is a common side effect of insulin therapy(1) and Levemir is the first insulin to show less weight gain versus other basal insulins in 12 of 12 controlled clinical trials. Among people with diabetes, 90 to 95 percent have type 2 diabetes(2) and 80 percent of people with diabetes are overweight or obese(3).

Additionally, an analysis of a sub-group of this study of type 2 diabetes patients (n=511) focused on patients who switched from NPH or glargine to Levemir. These patients experienced significant improvement in A1C, and reduced episodes of major hypoglycemia. Both patient groups also experienced weight reduction.

PREDICTIVE Study Key Findings (Poster# 511-P)
These results and the findings of a separate sub-group analysis were presented at the 66th Scientific Sessions of the American Diabetes Association in Washington, D.C.

Mark

[Nejeda]

I've found with the Levemir I had to cut back the amount I take by a good thirty units because I found that my blood sugar was constantly low.

I've also found that the Levemir doesn't last as long as the Lantus does, the Lantus stayed in my system longer, the Levemir I can tell when it wears off, I begin to feel ill.

[BriOnH]

I've found with the Levemir I had to cut back the amount I take by a good thirty units because I found that my blood sugar was constantly low.

I've also found that the Levemir doesn't last as long as the Lantus does, the Lantus stayed in my system longer, the Levemir I can tell when it wears off, I begin to feel ill.

30 units? May I ask how much you take/took of each? That's a VERY significant dose, no matter how much you are taking.

Mick,
If you are out there, how has the switch been going for you?

[Nejeda]

30 units? May I ask how much you take/took of each? That's a VERY significant dose, no matter how much you are taking.


On the Lantus the doctor had me on 100units and now I'm on 70units of the Levemir

[BriOnH]

On the Lantus the doctor had me on 100units and now I'm on 70units of the Levemir

A 30% decrease! I will for sure be keeping that in mind if i switch and my doctor tells me its a 1 to 1 ratio of lantus to levemir. Thank you.

[Mick]

Mick to Earth, Reporting in!!

Ok, well, a bit more than a week on the Levemir so far. I began with my same dose as I was on with the Lantus--18U. So far, I've had to cut back to 16U, and I'm still waking up with fairly low fasting blood sugars--in the 50s, which is a bit too low even for me. I'm pretty good during the day, however, and I even did a fast yesterday to see how even my readings were with no food or bolus injections--they stayed pretty flat, dropping slightly during the day, so I guess I could cut another half unit from my Levemir dose. I don't think I'm getting quite 24 hours out of it, but I am getting more than the 20 hours I got from the Lantus, because my after-dinner readings are not rising so much, and I've been able to cut back on the extra dinner bolus (to cover my basal short-fall) by about half. So, in all, I've been able to cut back my total insulin dosage from about 36U to about 31U--and if my math is right (duh, I'm an official math dunderhead!), that's a 14% reduction. The reduction in insulin has enabled a corresponding reduction in both food and in corrections of both food and insulin--which is what we were looking for with this change, so I'd have to say that it's been pretty positive so far.

Michael
T1 since 1966

[Tyler]

For those using Levemir, what time are you injecting it?

[TxTechKimmy]

I inject it around 6am

[TxTechKimmy]

Sorry..meant 6 am and 6 pm

[Mick]

I inject my entire basal at 10:30 PM.

Michael

[BriOnH]

Mick to Earth, Reporting in!!

Ok, well, a bit more than a week on the Levemir so far. I began with my same dose as I was on with the Lantus--18U. So far, I've had to cut back to 16U, and I'm still waking up with fairly low fasting blood sugars--in the 50s, which is a bit too low even for me. I'm pretty good during the day, however, and I even did a fast yesterday to see how even my readings were with no food or bolus injections--they stayed pretty flat, dropping slightly during the day, so I guess I could cut another half unit from my Levemir dose. I don't think I'm getting quite 24 hours out of it, but I am getting more than the 20 hours I got from the Lantus, because my after-dinner readings are not rising so much, and I've been able to cut back on the extra dinner bolus (to cover my basal short-fall) by about half. So, in all, I've been able to cut back my total insulin dosage from about 36U to about 31U--and if my math is right (duh, I'm an official math dunderhead!), that's a 14% reduction. The reduction in insulin has enabled a corresponding reduction in both food and in corrections of both food and insulin--which is what we were looking for with this change, so I'd have to say that it's been pretty positive so far.

Michael
T1 since 1966
Sounds good! Thanks for the info on your switch.

[kiwi]

So glad to find this thread. Thanks for all the information.
]I am switching to Levemir and novorapid from Lantus and Humalog. I have been hunting for information about how to, what to expect, and how it has generally affected control.
It will be interesting to see if it makes a difference for me.
I was finding Lantus was way better than N but was a bit too unpredictable and certainly not covering 24hours. Plus it seemed to drop effectiveness after about 35 days even though it was refridgerated. As I was not using all the vial (even sharing the vial with my type1 daughter) we were wasting a lot of it.
Looks like the pen for levemir will be more convenient especially for travelling.
I am hoping to have my levels established before I travel with a provincial team early July.
Do you find Levemir affected by exercise?
Thanks again.

[JasonJayhawk]

I haven't logged in to this forum in over 18 months, and was just skimming by and saw this thread. Decided to post to it after waiting a few days to see the results posted by others, such as from Mick, to avoid tainting any reports!

I'll tell you the scoop I've received from my endocrinologist, who was employed by Novo Nordisk to train other Endocrinologists in the Midwest USA.

First, Levemir and Lantus are not a 1 unit to 1 unit exchange, though this is the typical starting point that patients are recommended to start. You actually get less bang-for-the-buck for one unit of Levemir than with Lantus. Of course, YMMV, but this is how it is being trained to the public. If you take 20 units of Lantus, you may very well be taking 26 units of Levemir. Important thing is to not feel bad if you're taking "more insulin." You're really not -- there just is no true way to measure the potency of one unit of insulin. Some of the old foggies around here probably remember the days when each vial of insulin they received had a different potency.

A positive thing that patients with Levemir have been reporting is lack of stinging (due to the near-neutral pH) of Levemir.

Okay, on to a bit of "bad" news for everyone who thought it would provide 24 hour coverage. If you're wanting the longest coverage, you'd better go back to Lantus. For type 1 diabetes, Levemir is highly recommended to dose twice a day. Yes, you heard me right... Twice a day Levemir is recommended for Type 1's.

Why? Levemir actually peaks a "bit more" than Lantus. The literature, according to my endo, is showing that Levemir peaks around hour 8. This peak is significant if you take your entire day's basal in one dose. Taking it as two doses will lessen the peak quite a bit, to make it almost flat again.

I do believe that the pamphlet that comes with a vial of Levemir details this on a graph. I think they show two different dose concentrations (units per kilogram of patient weight). The 0.2 units/kg dose and the 0.4 units/kg dose show that the latter has a peaking action.

The "scoop" is that more literature is being worked on that will report that twice-a-day Levemir provides better control than Lantus (but I don't know if they are comparing it to twice-a-day Lantus).

I'm going to crawl back into lurk mode again... but I was hoping that this "report" would provide another insight into Lantus. I trust my source on this, as she was speaking at the endo training conferences. But of course, YMMV... (but from what I've read in this forum, everyone's experiences seem to match this, except for the report that the dosing is 1:1 with Lantus, but maybe their basal coverage wears off much sooner than with Lantus, and they haven't noticed it yet?). :hmmmm2:

---
Personally, I take 2/3 of my daily Levemir dose at night, around 9:30 PM, and the other 1/3 in the morning. The "peak" that Levemir has actually seems to hit during the time when a bit of my dinner is still digesting. I use this as an advantage and find myself waking up in more decent ranges for the past 4 months. (I started using Levemir before it was on the market -- my endo provided the samples. :D)

[TxTechKimmy]

I too take my Levemir in two doses and find it works a heck of a lot better for me that way. I was previously on NPH and WOW...I can tell a BIG difference. Additionally, I am not nearly as hungry on the Levemir, which is awesome.

[BriOnH]

First, Levemir and Lantus are not a 1 unit to 1 unit exchange, though this is the typical starting point that patients are recommended to start. You actually get less bang-for-the-buck for one unit of Levemir than with Lantus. Of course, YMMV, but this is how it is being trained to the public. If you take 20 units of Lantus, you may very well be taking 26 units of Levemir. Important thing is to not feel bad if you're taking "more insulin." You're really not -- there just is no true way to measure the potency of one unit of insulin. Some of the old foggies around here probably remember the days when each vial of insulin they received had a different potency.


Granted it's a small population, but every instance of switching has showen that it is more bang for the buck, and a decrease of levemir has been needed compared to the lantus dose. That could be because it needs to be given twice a day, if it truely does need to be given twice a day, but then again some experience it lasts longer then lantus. I take the word of patients when it comes to the effectiveness and side effects of medication over doctors, when it comes to prescribed medication, any day of the week.

[JasonJayhawk]

Hi Bri,

It will be interesting to see a large population of what the total daily dosage is for Levemir vs. Lantus. All I can do is report what my endo said. I'm actually taking more Levemir than I was of Lantus per day (about 8 units more), and her patients were having the same resuls with it.

But you're right...I wonder if the dose splitting has anything to do with it.

Looks like the biggest claim is that the smaller the doses, the smaller the peaks from it. At least that info is actually listed on the thin-papered printout. (Think those thin papers would make good kite skins??)

Back to lurking mode. :) :goodnight

[BriOnH]

Jason,
You bring good info/discussion in! Comon and post. Everyone is doing it :D

[Cheer-Phil-ly]

Still nothing about lantus and WEIGHT GAIN!
I started on Lantus on May 5th and have eaten less, exercised more and have gained around 25 lbs that I DO NOT NEED! Some seems to be that I am retaining more fluid... going to see my doctor this afternoon.

~~~~~~~~~~~~~~~
Type 2 for over 20 years

[JasonJayhawk]

I started on Lantus on May 5th and have eaten less, exercised more and have gained around 25 lbs that I DO NOT NEED! Some seems to be that I am retaining more fluid... going to see my doctor this afternoon.

What did your doctor say?

If you are coming down from highs (over 180 mg/dl), down to "normal" levels, it could be that your body is preparing for a new high. This is not uncommon for newly diagnosed Type 1's. Bloating will occur because normally, that water is excreted as urine, but now that glucose levels are within "designed limits," the body stores that water in preparation for the next time it needs to be used for urine excretion.

After a few weeks, it will go down.

Also, some people are startled that insulin causes weight gain. It's a hormone that builds fat from glucose... before diagnosis, people could eat all they wanted, and they urinated it all out (kidneys remove glucose above 180 mg/dl in healthy adults). Now that they're using insulin, they are finding that they will need to consume less calories than before.

[UpNorth]

I take my whole Levemir dose in the evening around 10-11pm...

[JasonJayhawk]

BriOn,

Thanks for looking up the action profiles. It saved me the time from looking. Perhaps the layperson :stupido2: feels intimidated by something else, rather than laying out the peer-reviewed and scientific perspective.

I'm from Kansas, where evolution, radioactive carbon dating, and geotectonic plate theory had been removed from scientific standards for a couple years. I used to wonder how that could have ever happened, but now it doesn't take long for us to realize how that can happen. <grin> :rofl:

[DeusXM]

May I settle something here? I used to be a patient at RD+E, the #1 research centre for diabetes in Europe. As a result I was one of the first people in Britain to try Levemir.

Broadly speaking, the differences beween Lantus and Levemir are minimal. Lantus lasts slightly longer and Levemir has a slightly flatter action profile. Lantus delays its action by crystalisation from being more acidic than the body, Levemir binds to albumin in the blood stream.

Both Lantus and Levemir offer a significant reduction in weight gain over isophane/NPH/Insulatard because you don't have to feed a peak with Lantus or Levemir. Levemir is also supposed to offer a slight reduction in weight gain over Lantus too (hence the study as posted earlier stating so, where it clearly said). In fact, it said 'patients who switched from NPH or glargine to Levemir. These patients experienced significant improvement in A1C, and reduced episodes of major hypoglycemia. Both patient groups also experienced weight reduction.'

Glargine is the scientific name for Lantus - Lantus is insulin glargine, Levemir is insulin detemir.

NPH also contributes greatly to weight gain through delayed hypo awareness. NPH contains zinc, which is proven to impair the brain's ability to detect drops in blood sugar levels. As a result, people on either Lantus or Levemir are able to detect hypos earlier, and as such are able to treat them earlier before the sudden surge of adrenaline kicks in and suspends judgement about food intake.

In terms of dosages, it varies from person to person. Generally most people need fewer units of Lan. or Lev. compared to isophane. In terms of Lan. to Lev. conversions, this can vary considerably. Some need the same, some need rather a lot less, some need rather a lot more. There's also a select group of people for whom Levemir simply doesn't work for - when I was trialling Levemir I had to triple my basal dose from 20u to 60u and I was still hyperglycaemic, which led to me abandoning Lev. and returning back to isophane. The reason I went back to isophane was because I'd had some nasty problems with Lantus.

[DeusXM]

Levemir and NPH have totally different action profiles. Given that both are made by Novo Nordisk, for a start it doesn't even make business sense to release a new insulin with a similar action profile to one you've already been making for years. Levemir was designed as Novo's version of Lantus and has an even flatter (but shorter) action profile than Lantus.

I'll have a look around later for the CD I've got - the one that Novo gave out to the professionals on the release of Levemir, with all the studies, tests and illustrations. Like I said, I played a (very minor) role in getting Lantus available in the UK in the first place.

[DeusXM]

Ah, yes, here's the official clinical reports from when Levemir was being trialled:

[DeusXM]

And here's some more.

[DeusXM]

And some more again.

As far as I'm aware, these are pretty much ALL the research paper abstracts available on Levemir - all conclusively demonstrating a significantly different action profile to NPH

[jillsp]

But were all these studies sponsored by Novo? That only makes them a bit doubtful. Most drug companies cherry pick and fine tune their data or have to studies geared to make them look better.

From what I have seen and read and it says this in Levemir's PI, Levemir is dose dependent, meaning, the higher the dose the higher the peak. I'm not saying the peak looks like NPH, but I am saying that if you push the dose, you get a PEAK. They even have a peaking graph in the PI and in their glucose clamp study. That is not good or bad or better or worse than Lantus. Everyone reacts differently to different kinds of insulin, you can debate all day long about which is better, but the fact is, what works for me, might not work for you. Some people are rather viscious on here about "their" particular insulin. I thought this was a place for support and fact gathering. Not attacking each other about their own preference in insulin therapy.

[BriOnH]

And some more again.

As far as I'm aware, these are pretty much ALL the research paper abstracts available on Levemir - all conclusively demonstrating a significantly different action profile to NPH

Awesome! How did you get these Dues? It looks like the dr's notes during the trial. Awesome raw data; that is rare to find. Here is a link to the 'Official' prescribing information:

http://www.insulindevice.com/pdfs/LevemirPI.pdf

The GFR in the first levemir / nph graph never has it going above 2, which is odd.

Thank you very much for settling that.

[jillsp]

Awesome! How did you get these Dues? It looks like the dr's notes during the trial. Awesome raw data; that is rare to find. Here is a link to the 'Official' prescribing information:

http://www.insulindevice.com/pdfs/LevemirPI.pdf

The GFR in the first levemir / nph graph never has it going above 2, which is odd.

Thank you very much for settling that.

What's odd is when Levemir was given at the recommended .4 u/kg it has a larger hump that NPH. In that graph NPH peaks and then tapers off, but Levemir has that big ol hump.

Also, all those study highlights look like what pharmaceutical reps use to memorize clinicals that they present to doctors. Those are just outlines of the data presented to get Levemir approved.

[BriOnH]

What's odd is when Levemir was given at the recommended .4 u/kg it has a larger hump that NPH. In that graph NPH peaks and then tapers off, but Levemir has that big ol hump.

Also, all those study highlights look like what pharmaceutical reps use to memorize clinicals that they present to doctors. Those are just outlines of the data presented to get Levemir approved.

I think that graph is false. How can NPH not go above 2 Glucose Infusion Rate(gir's) in that study? The difference I see is that the first graph (figure 1) is for type 1's. I find it hard to believe, after all these years that NPH has been on the market, and that it really peaks at a GIR of 2 for type 1's when in the prescribing information for it, it has always gone up between 4-5 gir's regardless of type.

Do you know how one gets in the loop to receive that information?

Thinking of lantus as crystals, and levemir as something that binds to the red blood cells where oxygen is carried, makes me consider the switch more. Right now I am pretty happy with Lantus. Anyone out there that made the switch care to chime in on how it's going?

[jillsp]

I think that graph is false. How can NPH not go above 2 Glucose Infusion Rate(gir's) in that study? The difference I see is that the first graph (figure 1) is for type 1's. I find it hard to believe, after all these years that NPH has been on the market, and that it really peaks at a GIR of 2 for type 1's when in the prescribing information for it, it has always gone up between 4-5 gir's regardless of type.

Do you know how one gets in the loop to receive that information?

Thinking of lantus as crystals, and levemir as something that binds to the red blood cells where oxygen is carried, makes me consider the switch more. Right now I am pretty happy with Lantus. Anyone out there that made the switch care to chime in on how it's going?

You could always contact NovoNordisk, or even better have your doctor contact them with that specific question and he/she might be privy to more scientific information about that particular glucose clamp study. The thing is, that graph is what Novo chose to have in the PI, and typically companies don't want something that makes them look worse than what they are comparing themselves to. The graph can't be false, the FDA closely regulates and dictates labeling and what is shown in the package insert.

The criteria of that particular study may have been different which is why the GIR is different. You can't compare studies apples to apples b/c they are all set up so differently. The studies done for NPH were probably different than these for Levemir....just guessing, but that might explain the 2 vs the 4 or 5 that you see in NPH's labeling.

[BriOnH]

You could always contact NovoNordisk, or even better have your doctor contact them with that specific question and he/she might be privy to more scientific information about that particular glucose clamp study. The thing is, that graph is what Novo chose to have in the PI, and typically companies don't want something that makes them look worse than what they are comparing themselves to. The graph can't be false, the FDA closely regulates and dictates labeling and what is shown in the package insert.

The criteria of that particular study may have been different which is why the GIR is different. You can't compare studies apples to apples b/c they are all set up so differently. The studies done for NPH were probably different than these for Levemir....just guessing, but that might explain the 2 vs the 4 or 5 that you see in NPH's labeling.

The FDA and Drug Companies (with profits always in the back of their minds though) usually have a pretty good Quality Assurance, but I have caught them making mistakes before. For instance; They did it with Paxil stating that it is not physically addictive, and doesn't cause suicidal tendencies in teens. It wasn't until almost 10 years later that they retracted those statments.

Ideally in each study, the same scientific method should be followed as strictly as possible, or noted otherwise. Figure 1 still baffles me, ill look harder at it later.

[DeusXM]

Awesome! How did you get these Dues? It looks like the dr's notes during the trial.

Like I say, in a small way I was involved in making Levemir available in the UK. I also had a very good relationship with my care team.

Anyone out there that made the switch care to chime in on how it's going?

Levemir is now used more often at my new clinic (in a split dose) because a lot of people seem to be having trouble with DP on Lantus. However I refuse to use the stuff myself because it simply doesn't work for me - I must have too much albumin in my blood or something. Anyway, Lantus is working out fine for me - woke up this morning with a BG of 4.1 and that's now kinda normal for me. Basically, my argument when it comes to insulin is if you're getting good A1Cs (under 7%) on your current regime AND your insulin isn't affecting your lifestyle choices, there's no reason to change.

[Nejeda]

UPDATE: (heehee, sounds important) So, I've had to cut back even more on the Levemir, I woke up two days in a row with a fasting blood sugar that was extremely low. The first morning it was 24, and the second it was 32... but it also may have to do with the fact that I also have been losing weight like crazy... it's like I can't keep any weight on.

[sofaraway]

I started on lantus last week, i could have gone on either lantus or levemir. the nurse showed me some different pens and let me play and asked which I liked best. I chose the autopen24, so she said right you will go on lantus then. I had to question wheather she thought it would be a better insulin for me, as that was more important than which pen i liked best. As it was I am happy with the choice as I would rather have 1 shot of long acting, and she said in her expereince, not many people split lantus but alot split levemir.

results so far are ok, my daytime readings have come down from running 20mmol/l- off my meter (28mmol/l), to approx 15-20mmol/l.
My fasting blood sugars remain 11-17 mmol/l
so am increasing the dose slowly, 2 units/ every 3 days. have gone from 6units and currently taking 10 units.

was talking to a friend this morning and she takes 120units of lantus, Am i abnormal in taking such a small amount or does she take alot?
is it normal to go up this slowly to get correct dose?

If my before bedtime glucose is high ,average over past 7 days of 19.7 mmol/l range 12.9- 24.7 mmol/l. can I expect my fasting blood sugars to be in normal range with just the lantus? because that is what I/we are trying to sort before starting bolus insulin. my thinking is that if I do manage to get fasting blood glucose in range (4-7mmol/l is my target). when i start bolus insulin, the lantus dose will be too high because i'll be going to bed on and having more normal blood sugars through the day.

i'm possibly not understanding at all, or not explaining myself well, but if anyone could help it would be appreciated.

[vrocco1]

Realizing that I am a proven moron, please take this with a grain of salt. Your friend could have a significantly higher insulin resistance then you do, or he/she might weigh more, or it could be that he/she has a different metabolism then you do or finally, he/she might have less pancreatic function then you do. It is probably best not to compare your insulin usage with anyone else, although we do it here all of the time (that is why most of us don't pretend to be Doctors).

[DeusXM]

If my before bedtime glucose is high ,average over past 7 days of 19.7 mmol/l range 12.9- 24.7 mmol/l. can I expect my fasting blood sugars to be in normal range with just the lantus? because that is what I/we are trying to sort before starting bolus insulin. my thinking is that if I do manage to get fasting blood glucose in range (4-7mmol/l is my target). when i start bolus insulin, the lantus dose will be too high because i'll be going to bed on and having more normal blood sugars through the day.

No no no no no.

Sorry but you will never get anything approaching normal readings if you eat and don't have a bolus insulin. You need to be on bolus insulin NOW. Your readings are dangerously high and I'm frankly astonished you're not in hospital with DKA.

Your readings should be between 4 and 7 and go no higher than 9 at ANY time. If you are going to bed in the 19s and 20s there is no way on earth the right amount of Lantus for normal requirements will give you a normal FBS. Lantus isn't supposed to lower your blood sugar - it's just supposed to keep it steady between meals. If you're going to be at 19 and waking up at 19 then you're on the right amount of Lantus but you're certainly nowhere near on the right amount of insulin.

You need to be on Novorapid or Humalog as well as Lantus NOW. As in 'go to the emergency room' RIGHT NOW.

[vrocco1]

Again, the moron speaking, but do you test for ketones? Since you are MODY, perhaps they are still considering that you are T2. In that case, DKA may not be danger.

[sofaraway]

I have tested for ketones, every reading has been 0.0 even when my blood sugar has been over 28, so DKA isn't very likely. As I am MODY I do produce some of my own insulin.

Thanks for explaining Deus, i thought that it didn't make sense. I am suppossed to be in phone contact with my DSN tomorrow, so I will ask about starting bolus insulin (novorapid was the plan). they wanted me to wait until next thursday when I have an appointment with the doctor at clinic to start on bolus insulin. I was happy to start but they think it's too much to start at once.

thanks for the replies

[vrocco1]

Frankly, you are very lucky they have not started you on a mix. If so, you might (knowing the health care system) never get your Novarapid! I agree you need a meal time insulin, but since you are not producing ketones, you are probably not in any immediate danger as long as you remain hydrated. T2s do sometimes suffer from hyperosmolar coma rather then DKA.

Again, I do not pretend to be a Doctor, although others may. Best that you contact you health care provider ASAP.

[sofaraway]

The doctor did initially suggest mixed insulin, but I said I thought a basal bolus regime would be better because i wnat a s much flexibility as possible.

will make sure i call tomorrow, thanks

[vrocco1]

Excellent choice! Obviously, you are much smarter then I am (LOL). Good luck, and let us know how you make out!

[sofaraway]

spoke to the nurse today, lantus up to 12 units tonight. she said she'll speak to me on friday and then I should be able to start bolus insulin on monday. She does think that my fasting blood glucose will come down to below 10mmol/l with just the lantus.